Nitric-oxide

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 30-year-old pregnant woman exhibited lack of efficacy during treatment with nitric oxide for acute hypoxic respiratory failure secondary to an e-cigarette or vaping product use–associated lung injury (EVALI).

The pregnant woman (G2P0010), who had history of depression, hypothyroidism, IV drug abuse and hepatitis C, admitted to the hospital at 33 weeks of gestation with complaints of shortness of breath and chest discomfort. She was intubated, as she required increasing levels of oxygen. Chest CT showed diffuse ground-glass opacities. Her film array respiratory panel and gram stain were found negative, and she had failed (lack of efficacy) conventional therapies and inhaled nitric oxide [dosage not stated].

Subsequently, the woman was transferred in full airborne precautions for the initiation of mechanical support. There she was found to be hypoxic, and her oxygen saturation was 74%. The ratio of arterial oxygen partial pressure to fractional inspired oxygen was 56 despite 100% fraction of inspired oxygen and 20cm H ₂O of positive end-expiratory pressure. Venovenous extracorporeal membrane oxygenation support (ECMO) was started. The neonate in breech presentation was delivered by caesarean delivery immediately after cannulation in the ICU within 90 minutes of her arrival. Apgar score was 9. She also received anticoagulation therapy during the initiation of ECMO, which was held during the delivery. Eventually, she was extubated on day 2, and tested negative for COVID-19. She started nursing her baby on day 3 and discharged on day 7. Eventually, it was revealed that, she had been using "vaper" until the day of her hospitalisation. It was suspected that she had sustained severe acute hypoxic respiratory failure secondary to (EVALI).